阿奇霉素序貫療法治療急性盆腔炎性疾病的臨床觀察

王 瑋，劉 晨

(1.商洛市中心醫院婦科，商洛 726000；2.西北婦女兒童醫院婦二科，西安 710061)

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阿奇霉素序貫療法治療急性盆腔炎性疾病的臨床觀察

王 瑋1，劉 晨2

(1.商洛市中心醫院婦科，商洛 726000；2.西北婦女兒童醫院婦二科，西安 710061)

目的 探討阿奇霉素序貫療法治療盆腔炎性疾病的療效和安全性。方法 300例急性盆腔炎性疾病患者進行序貫療法(前期靜脈注射阿奇霉素500 mg，每日1次，1～2 d；后改為口服阿奇霉素250 mg，每日1次，共治療7 d)。治療結束當日、治療后第15天及第29天評估臨床有效率和細菌根除率。結果 病例樣本最常見的病原體為：沙眼衣原體(60株)、二路普氏菌(50株)、無乳鏈球菌(35株)、淋球菌(30株)和厭氧消化鏈球菌(30株)。臨床進行臨床有效率和細菌根除率分析，治療結束當日，沙眼衣原體感染者分別為100%(60/60)和72.7%(40/55)，二路普氏菌感染者分別為90%(45/50)和80%(40/50)，無乳鏈球菌感染者分別為85.7%(30/35)和57.1%(20/35)，淋球菌感染者分別為100%(30/30)和33.3%(10/30)，厭氧消化鏈球菌感染者分別為83.3% (25/30)和83.3%(25/30)。臨床有效率，第15天和第29天各菌種治療有效率均無顯著變化。細菌根除率和后期根除率均有所提高。相關的常見不良反應是腹瀉、注射部位疼痛和惡心，均為輕度或中度。結論 阿奇霉素序貫療法能夠有效治療盆腔多種病原微生物，包括喹諾酮耐藥菌引起的盆腔炎，且患者耐受性良好。

阿奇霉素；序貫療法；盆腔炎；沙眼衣原體；淋病奈瑟氏菌

A.stract:Objective To evaluate the efficacy and safety of azithromycin in the treatment of pelvic inflammatory disease (PID) that requires initial intravenous injection therapy. Methods Sequential therapy was performed in 300 patients with acute PID (in early stage，intravenous injection azithromycin (500 mg once a day) for 1～2 days followed by oral azithromycin (250 mg once a day，a total of 7 days treatment). At the end of treatment (EOT)，the 15th and 29th day，clinical effective rate and bacterial eradication rate were evaluated. Results The most commonly detected baseline causative pathogens wereChlamydiatrachomatis(60 strains)，Prevotellabivia(50 strains)，Streptococcusagalactiae(35 strains)onorrhoeaeandPeptostreptococcusanaerobius(respective 30 strains). The clinical effective rate and bacterial eradication rate analysis were carried out.At the EOT，C.trachomatiswere 100% (60/60) and 72.7%(40/55)，P.copriwere 90%(45/50) and 80.0%(40/50)，Streptococcusagalactiaewere 85.7%(30/35) and 57.1%(20/35),Gonococcuswere 100%(30/30) and 33.3%(10/30)，andPeptostreptococcusanaerobiuswere both 83.3%(25/30). The above descriptions of all kinds of bacteria had no significant change for clinical effective rate and the bacterial eradication rate was increased in late stage. Common treatment-related adverse events were diarrhea， injection site pain， and nausea. All adverse events were mild or moderate in severity. Conclusion Azithromycin intravenous-to-oral sequential therapy demonstrated excellent clinical and bacteriological effects for PID caused by various etiologic agents including quinolone-resistant strains and strains with low susceptibility to azithromycin atinvitrotesting. The therapy was well tolerated in the treatment of PID in clinic.

盆腔炎性疾病(pelvic inflammatory disease，PID)主要包括子宮內膜炎、輸卵管炎、輸卵管卵巢膿腫和盆腔腹膜炎。PID會導致不孕、異位妊娠和慢性盆腔疼痛等并發癥[1-2]。PID微生物病原學發現，抗菌療法具有廣譜抗菌效果，治療范圍包括抗淋球菌、沙眼衣原體、支原體、無氧和有氧細菌。……